Provider Demographics
NPI:1740706985
Name:LIBERTY DENTAL PLAN OF NEVADA, INC.
Entity type:Organization
Organization Name:LIBERTY DENTAL PLAN OF NEVADA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARZENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERCZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-703-6999
Mailing Address - Street 1:340 COMMERCE STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1358
Mailing Address - Country:US
Mailing Address - Phone:949-447-3015
Mailing Address - Fax:
Practice Address - Street 1:6285 S RAINBOW BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3289
Practice Address - Country:US
Practice Address - Phone:888-703-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY DENTAL PLAN CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
.Other.